Clinical guidelines on antidepressant withdrawal urgently need updating

Davies, James; Read, John; Hengartner, Michael Pascal; Cosci, Fiammetta; Fava, Giovanni A.; Chouinard, Guy; Os, Jim van; Nardi, Antônio Egídio; Gøtzsche, Peter C; Groot, Peter C.; Offidani, Emanuela; Timimi, Sami; Spada, Marcantonio M.; Guy, Anne

doi:10.1136/bmj.l2238

Cited by 36 publications

(33 citation statements)

References 14 publications

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“…Burn and Baldwin, 2018). This has also been the official position of both the American Psychiatric Association (APA) and National Institute for Health and Care Excellence (NICE) and many leading psychiatrists in the USA and the UK since the early 2000s (National Institute for Health and Care, 2009; American Psychiatric Association, 2010), although, as we will soon state, this position has now changed owing to its being contrary to the evidence base (Davies and Read, 2019 a ; Davies et al ., 2019; Horowitz and Taylor, 2019). Below we will therefore outline what conclusions and practical implications can be drawn from the sparse, but vitally important, scientific evidence available.…”

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Antidepressant withdrawal – the tide is finally turning

Hengartner

Davies

Read

2019

Epidemiol Psychiatr Sci

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Withdrawal reactions when coming off antidepressants have long been neglected or minimised. It took almost two decades after the selective serotonin reuptake inhibitors (SSRIs) entered the market for the first systematic review to be published. More reviews have followed, demonstrating that the dominant and long-held view that withdrawal is mostly mild, affects only a small minority and resolves spontaneously within 1–2 weeks, was at odd with the sparse but growing evidence base. What the scientific literature reveals is in close agreement with the thousands of service user testimonies available online in large forums. It suggests that withdrawal reactions are quite common, that they may last from a few weeks to several months or even longer, and that they are often severe. These findings are now increasingly acknowledged by official professional bodies and societies.

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confidence: 99%

Antidepressant withdrawal – the tide is finally turning

Hengartner

Davies

Read

2019

Epidemiol Psychiatr Sci

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“…Writing in The BMJ , they warned that antidepressants cause withdrawal effects that can be long lasting and severe and that this is not sufficiently recognised in the current guidelines 56…”

Section: Short Term Outcomesmentioning

confidence: 99%

NICE guidance on depression: 35 health organisations demand “full and proper” revision

Wise¹

2019

BMJ

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“…Withdrawal problems have been recognised in the scientific literature, 9 and recently, there has been pressure to modify National Institute for Health and Care Excellence (NICE) guidelines in order to start considering withdrawal a severe, and long-term problem. 10 But overall, for a long time, withdrawal problems were not considered a significant issue in academic psychiatry. This remained until 2019, when the UK Royal College of Psychiatrists (RCPsych), for the first time, admitted that the reality for many patients was quite different: withdrawal symptoms could be more severe and last longer than had always been assumed.…”

Section: Introductionmentioning

confidence: 99%

How user knowledge of psychotropic drug withdrawal resulted in the development of person-specific tapering medication

Groot

2020

Therapeutic Advances in Psychopharmacology

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Coming off psychotropic drugs can cause physical as well as mental withdrawal, resulting in failed withdrawal attempts and unnecessary long-term drug use. The first reports about withdrawal appeared in the 1950s, but although patients have been complaining about psychotropic withdrawal problems for decades, the first tentative acknowledgement by psychiatry only came in 1997 with the introduction of the ‘antidepressant-discontinuation syndrome’. It was not until 2019 that the UK Royal College of Psychiatrists, for the first time, acknowledged that withdrawal can be severe and persistent. Given the lack of a systematic professional response, over the years, patients who were experiencing withdrawal started to work out practical ways to safely come off medications themselves. This resulted in an experience-based knowledge base about withdrawal which ultimately, in The Netherlands, gave rise to the development of person-specific tapering medication (so-called tapering strips). Tapering medication enables doctors, for the first time, to flexibly prescribe and adapt the medication required for responsible and person-specific tapering, based on shared decision making and in full agreement with recommendations in existing guidelines. Looking back, it is obvious that the simple practical solution of tapering strips could have been introduced much earlier, and that the traditional academic strategy of comparisons from randomised trials is not the logical first step to help individual patients. While randomised controlled trials (RCTs) are the gold standard for evaluating interventions, they are unable to accommodate the heterogeneity of individual responses. Thus, a more individualised approach, building on RCT knowledge, is required. We propose a roadmap for a more productive way forward, in which patients and academic psychiatry work together to improve the recognition and person-specific management of psychotropic drug withdrawal.

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Clinical guidelines on antidepressant withdrawal urgently need updating

Cited by 36 publications

References 14 publications

Antidepressant withdrawal – the tide is finally turning

Antidepressant withdrawal – the tide is finally turning

NICE guidance on depression: 35 health organisations demand “full and proper” revision

How user knowledge of psychotropic drug withdrawal resulted in the development of person-specific tapering medication

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